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Marel (MAlattie e Rischi Emergenti sul Lavoro) project provides, among the main purposes, information on occupational exposure associated to putative work-related diseases. In order to achieve this goal, a network of Occupational Medicine consultation centres has been created. Occupational exposure data are the key information of the Marel system with details that allow analyses about occupational sectors and job-titles. The data recorded in the experimental phase refer to 843 workers visited in five outpatient consultation centres. Women are about 25% of the total and have a lower average age than men, respectively 53 and 59 years. Each worker reports on average two diseases. Among the reported diseases, “Other intervertebral disc disorders” is the most represented group (12.3% out of the total). The homogeneous and systematic collection of information from Occupational Medicine consultation centres can provide a large amount of information useful to design preventive interventions. It also allows to study cases of diseases that, by their nature or their particular relationships with unrecognized professional risk factors, are not yet considered work-related.

Occupational health surveillance is an important issue in many countries since working conditions and occupational exposures are rapidly changing. We aim to create an Italian network of occupational disease consultation centres to which patients are referred for potentially work-related diseases. The pilot network, namely MAREL (MAlattie e Rischi Emergenti sul Lavoro), will be constituted by five Italian occupational disease consultation centres. Each centre, from each patient, will collect data through a standardised form using an online database platform. The data will be coded according to national and international classifications. To detect emerging disease/occupational-exposure associations we intend to apply the proportional reporting ratio used in pharmacosurveillance and adopted by the French occupational disease surveillance system (RNV3P). The Italian network MAREL will contribute to surveillance systems (i.e. MALPROF) by the detection of new and emerging work-related diseases and occupational risks.

This article summarizes the published data and several practical experiences of organ transplant patients who practice sports, with the purpose of giving a picture which can help to understand the real performance possibilities of these patients and any limitations and/or contraindications to practising competitive sports. Literature indicates that solid organ (heart, liver, kidney) transplant recipients who practice competitive sports show good tolerance to immunosuppressive therapy, good function of the transplanted organ at rest and under exertion, good overall physical condition as a result of training, and a positive perception of their psycho-physical condition. In transplant recipients, the risks connected with sports are those of infection and cardiometabolic risks due to the side-effects of immunosuppression. The first is tackled with suitable prophylactic measures (personal hygiene, vaccinations). The second is tackled primarily with personalised exercise and used as a drug and also suitable pharmacological therapies. Traumatological risk does not appear to be hazardous for the transplanted organ, even in several contact sports such as football and basketball. There is evidence of transplant recipients who have returned to practice sports at the same level as that before the illness which had led them to the transplant, succeeding in competing on a par with healthy athletes of the top or Master category, while we are not aware of transplant recipients who have reported negative consequences for the transplanted organ because they practice sport, even at competitive levels. Transplant recipients who practice sports at an amateur or professional level cannot be considered representative of the entire population of transplant recipients, but they do offer a unique opportunity to become acquainted with the higher limits of the possibilities of functional recovery after a transplant. This aspect should be considered to formulate the criteria for granting fitness for competitive sports and, above ali, it allows to use these experiences to contrast the belief according to which transplants and sports cannot coexist.

Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disorder defined by the combination of biochemical abnormalities, tubulointerstitial nephritis, and uveitis. We describe a 12-year-old female, presented with a ten-day history of fever, characterized by sudden onset and rapid spontaneous resolution in few hours, accompanied by shivering, extreme fatigue, and loss of appetite. Laboratory values were consistent with renal failure of tubular origin. Renal biopsy confirmed a tubulointerstitial nephritis, with acute tubulitis, polymorphonuclear infiltration, and microabscesses. The renal interstitium was occupied by a dense inflammatory infiltrate, consisting of lymphocytes, plasma cells, and neutrophils. Glomerular structures were preserved. Ophthalmological examination that suggested a previous asymptomatic bilateral uveitis and HLA typing (HLA-DQA1*0101/0201 and HLA-DQB1*0303/0503) further supported the suspect of TINU syndrome. TINU syndrome is probably an underdiagnosed disorder, responsible for many cases of idiopathic anterior uveitis in young patients, especially in those who have asymptomatic renal disease and when proper diagnostic tests are not performed at the time of presentation.

Presso il Centro Trapianti di Rene del Policlinico S. Orsola di Bologna nel corso del 2011 sono stati sottoposti a trapianto 62 pazienti di cui 51 da donatore cadavere (43 singoli reni, 3 doppi trapianti di rene, 4 trapianti combinati rene/fegato, 1 trapianto combinato rene/cuore) e 11 da donatore vivente; per la realizzazione dell’attività sono stati utilizzati complessivamente 65 reni. Complessivamente si è registrata una riduzione dell’attività trapiantologica rispetto al 2010 (-10%); in linea con la media Nazionale che risulta in calo di circa il 10%. Si è assistito ad un incremento dell’attività di trapianto da donatore vivente del 30% rispetto ai dati del 2010 e al continuo sviluppo di programmi di trapianto combinato. Anche nel 2011 si è confermata una buona collaborazione con il Centro Regionale Trapianto, con il Centro Interregionale AIRT e con le altre strutture trapiantologiche nazionali (NITp, OCST); non si sono registrati rifiuti di organi per motivi di carattere organizzativo o logistico. Anche nel 2011 le strutture logistiche e le procedure operative utilizzate dal Centro Trapianti di Bologna sono stati sottoposti a verifiche dei requisiti di qualità; nel corso dell’anno il Dipartimento di cui fa parte il Centro Trapianti ha superato la fase di accreditamento regionale. Nel corso dell’anno è stata divulgata ai pazienti candidati a trapianto renale la guida al trapianto che fornisce informazioni sugli aspetti gestionali e pratici delle diverse fasi del Programma del Trapianto (lista di attesa, trapianto, follow-up post-trapianto) con l’intento di rispondere ai più frequenti quesiti dei pazienti. L’esperienza del Centro Trapianto di Rene del S. Orsola nelle diverse fasi (inserimento in lista di attesa, terapia immunosoppressiva, follow-up post trapianto) è stata oggetto di pubblicazione su riviste Nazionali ed Internazionali e di comunicazione in Congressi di Nefrologia, Chirurgia ed Immunologia. L’Unità Operativa di Nefrologia Dialisi e Trapianto del Policlinico S. Orsola è sede della Lista Unica Regionale per il trapianto di rene (circolare dell’Assessorato alla Sanità della Regione Emilia-Romagna n. 12 del 30 maggio 2001); coordina, in collaborazione con i colleghi dei Centri Trapianto di Modena e di Parma, la valutazione di idoneità al trapianto dei reni proposti dal Centro Regionale Trapianti e, in collaborazione con la Unità Operativa di Genetica Medica di Parma, l’allocazione degli stessi. L’attività complessiva attinente alla Lista Unica è riportata in dettaglio in una specifica sezione del presente report regionale. Gli obiettivi del Centro per l’anno 2012 sono costituiti dal mantenimento di un’attività di trapianto da donatore cadavere in linea con i dati storici del Centro, dall’incremento dei Trapianti da donatore vivente con lo sviluppo di programmi di informazione sul territorio regionale, dalla periodica rivalutazione dei pazienti con comorbidità note (in particolare patologia cardiovascolare) o da più tempo inseriti in lista e dal consolidamento dei programmi di trapianto combinato.

Physical performance of kidney transplanted patients in challenging environments, such as deserts, has been poorly studied. Six kidney transplanted (T: 5 males, 1 female; 45±6 yrs) and 8 control (C: 5 males, 3 females; 49±13 yrs) subjects participated in a 5-day desert trek. Blood pressure, hydration status (Height2/Rz by bioimpedance), heart rate, energy expenditure (by SenseWear Pro Armband) and walking velocities were recorded during each daily trekking stage (GPS-assisted wearable devices). Systo-diastolic blood pressure did not differ between C (119/77±12/8 mmHg) and T (121/77±10/6 mmHg) groups throughout the study. The hydration status was stable from day 1 (Ht2/Rz: 64±13 cm2/Ohm in T and 59±12 cm2/Ohm in C subjects) to day 5 (66±11 cm2/Ohm in T and 61±13 cm2/Ohm in C subjects) in both groups. Two patients on steroid treatment showed a relative hyperhydration. Mean heart rate did not differ between T (135±10 bpm) and C (136±5 bpm) subjects throughout the study, although a reduction from day 1 to day 5 was observed in T subjects only (p 55 ml/min showed acceptable physical performance and acclimatization to desert environment, suggesting a good long-term outcome of transplantation

viene riportata l'esperienza di un gruppo di trapiantati di rene per quanto rigurda le capacità di adattamento in condizioni critiche in termini di riposta cardiovascolare e consumo metabolico

Viene valutata la capacità predittiva della funzione renale a distanza dei sistemi più in uso per la valutazione istologica pre trapianto (Karpinsky-Nyberg) dei reni di donatori marginali

Immunological evaluation by panel reactive antibody (PRA) and determination of anti-HLA specificity is an important phase in the assessment of patients awaiting kidney transplant. The main causes of immunization are previous solid organ transplants, blood transfusions, and pregnancy; immunogenicity can also be triggered by vascularized tissue grafts. Immune induction by cryopreserved bone allografts is not yet fully understood. We report the case of a 19-year-old patient with osteosarcoma who underwent resection of the left proximal tibia with reconstruction using human bone in 1997 (donor typing: A3, A29 (19) - B44 (12), Bw4 - DR13 (6), DR7, DR52, DR53). The patient was subsequently placed on the waiting list for a cadaver donor kidney transplant because of chronic kidney failure caused by cisplatin toxicity. Pretransplant immunological screening using the CDC (complement dependent cytotoxicity) technique revealed a PRA of 63% and anti-A3 and anti-A68 antibodies. The presence of IgG antibody specificity against class I and class II donor antigens (specifically anti-A3, B44, DR7 antibodies) was highlighted using flow cytometry (Tepnel-Luminex). Further immunological studies using single HLA specificity analysis (LSA Class I - II - Tepnel-Luminex) detected direct antibodies against all donor antigen specificities. This is the first reported case of immune induction after a bone graft in a kidney transplant candidate. It underlines the importance of the availability of HLA typing data of all human allograft donors.